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Disease Severity and Perinatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 (COVID-19).

Publication ,  Journal Article
Metz, TD; Clifton, RG; Hughes, BL; Sandoval, G; Saade, GR; Grobman, WA; Manuck, TA; Miodovnik, M; Sowles, A; Clark, K; Gyamfi-Bannerman, C ...
Published in: Obstet Gynecol
April 1, 2021

OBJECTIVE: To describe coronavirus disease 2019 (COVID-19) severity in pregnant patients and evaluate the association between disease severity and perinatal outcomes. METHODS: We conducted an observational cohort study of all pregnant patients with a singleton gestation and a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who delivered at 1 of 33 U.S. hospitals in 14 states from March 1 to July 31, 2020. Disease severity was classified by National Institutes of Health criteria. Maternal, fetal, and neonatal outcomes were abstracted by centrally trained and certified perinatal research staff. We evaluated trends in maternal characteristics and outcomes across COVID-19 severity classes and associations between severity and outcomes by multivariable modeling. RESULTS: A total of 1,219 patients were included: 47% asymptomatic, 27% mild, 14% moderate, 8% severe, 4% critical. Overall, 53% were Hispanic; there was no trend in race-ethnicity distribution by disease severity. Those with more severe illness had older mean age, higher median body mass index, and pre-existing medical comorbidities. Four maternal deaths (0.3%) were attributed to COVID-19. Frequency of perinatal death or a positive neonatal SARS-CoV-2 test result did not differ by severity. Adverse perinatal outcomes were more frequent among patients with more severe illness, including 6% (95% CI 2-11%) incidence of venous thromboembolism among those with severe-critical illness compared with 0.2% in mild-moderate and 0% in asymptomatic (P<.001 for trend across severity). In adjusted analyses, severe-critical COVID-19 was associated with increased risk of cesarean birth (59.6% vs 34.0%, adjusted relative risk [aRR] 1.57, 95% CI 1.30-1.90), hypertensive disorders of pregnancy (40.4% vs 18.8%, aRR 1.61, 95% CI 1.18-2.20), and preterm birth (41.8% vs 11.9%, aRR 3.53, 95% CI 2.42-5.14) compared with asymptomatic patients. Mild-moderate COVID-19 was not associated with adverse perinatal outcomes compared with asymptomatic patients. CONCLUSION: Compared with pregnant patients with SARS-CoV-2 infection without symptoms, those with severe-critical COVID-19, but not those with mild-moderate COVID-19, were at increased risk of perinatal complications.

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Published In

Obstet Gynecol

DOI

EISSN

1873-233X

Publication Date

April 1, 2021

Volume

137

Issue

4

Start / End Page

571 / 580

Location

United States

Related Subject Headings

  • Young Adult
  • Venous Thromboembolism
  • United States
  • SARS-CoV-2
  • Risk Factors
  • Premature Birth
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Perinatal Mortality
  • Patient Acuity
 

Citation

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Metz, T. D., Clifton, R. G., Hughes, B. L., Sandoval, G., Saade, G. R., Grobman, W. A., … for the                                  Eunice Kennedy Shriver                                  National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. (2021). Disease Severity and Perinatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 (COVID-19). Obstet Gynecol, 137(4), 571–580. https://doi.org/10.1097/AOG.0000000000004339
Metz, Torri D., Rebecca G. Clifton, Brenna L. Hughes, Grecio Sandoval, George R. Saade, William A. Grobman, Tracy A. Manuck, et al. “Disease Severity and Perinatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 (COVID-19).Obstet Gynecol 137, no. 4 (April 1, 2021): 571–80. https://doi.org/10.1097/AOG.0000000000004339.
Metz TD, Clifton RG, Hughes BL, Sandoval G, Saade GR, Grobman WA, et al. Disease Severity and Perinatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 (COVID-19). Obstet Gynecol. 2021 Apr 1;137(4):571–80.
Metz, Torri D., et al. “Disease Severity and Perinatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 (COVID-19).Obstet Gynecol, vol. 137, no. 4, Apr. 2021, pp. 571–80. Pubmed, doi:10.1097/AOG.0000000000004339.
Metz TD, Clifton RG, Hughes BL, Sandoval G, Saade GR, Grobman WA, Manuck TA, Miodovnik M, Sowles A, Clark K, Gyamfi-Bannerman C, Mendez-Figueroa H, Sehdev HM, Rouse DJ, Tita ATN, Bailit J, Costantine MM, Simhan HN, Macones GA, for the                                  Eunice Kennedy Shriver                                  National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Disease Severity and Perinatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 (COVID-19). Obstet Gynecol. 2021 Apr 1;137(4):571–580.

Published In

Obstet Gynecol

DOI

EISSN

1873-233X

Publication Date

April 1, 2021

Volume

137

Issue

4

Start / End Page

571 / 580

Location

United States

Related Subject Headings

  • Young Adult
  • Venous Thromboembolism
  • United States
  • SARS-CoV-2
  • Risk Factors
  • Premature Birth
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Perinatal Mortality
  • Patient Acuity